Deciding to start or grow your family is an exciting time. If the test keeps coming back negative, however, you may start to worry – “What if it never happens to us?”
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It’s a question that many people face. The National Institutes of Health estimates that 9% of men and men of male fertility (MAB) experience fertility problems.
In men and AMAB people, decreased fertility is usually associated with low testosterone levels, commonly referred to as “low T”. Low T = low sperm count = lower chance of reproduction.
The key here, however, is lower probability. Living with low T does not mean that you and your partner will not be able to conceive a child. There are ways to increase your chances.
We spoke with endocrinologist Kevin Pantalone, DO, about how low testosterone affects fertility and how you can increase your chances.
The role of testosterone in fertility
In men whose testosterone levels are in the normal range, a single ejaculation can contain more than 15 million sperm per milliliter. If your testosterone levels are low, your sperm count may also be low, which reduces your chances of conceiving.
However, let’s get micro for a minute. This is the brief history of how sperm is made:
- Your pituitary gland (a part of your brain that controls the release of hormones) produces two hormones: follicle-stimulating hormone (FSH) and luteinizing hormone (LH).
- LH tells your testes to produce testosterone.
- Testosterone then works with FSH to produce sperm.
Dr. AS says Pantalone many Testosterone is needed inside your testicles to make sperm. So if you’re experiencing low testosterone, you may be stuck in step 2, which means you end up making less sperm.
“This is the main issue we see in men with low testosterone and infertility. Low testosterone means a lower sperm count. This doesn’t mean you can’t get pregnant, but it does reduce the chances,” notes Dr. Pants.
Additionally, living with low testosterone can affect your sexual function, says Dr. Pants. Low libido and erectile dysfunction are common symptoms of low T, which can further decrease the chances of conception.
Testosterone therapy and fertility
OK, so low T means you need more T, which means you need testosterone therapy, right?
Actually, no. It may sound counterintuitive, but testosterone therapy can actually prevent you from producing sperm.
“Testosterone therapy will increase your circulating testosterone in your blood, but it will not increase testosterone in the testicles, which is where it is needed for sperm production,” explains Dr. Pants. “In fact, testosterone therapy can further reduce your sperm count, so it’s not recommended for people who want to start a family.”
Think of it as supply and demand. When you increase your testosterone through patches, pills, injections, or creams, your body thinks it has an adequate supply of testosterone and so does not produce more in your testicles. This means that testosterone levels in your testicles – where it matters for sperm production – will remain low.
Ways to increase sperm count
If hormone therapy won’t increase your sperm count, what will?
There are many myths about male fertility (no, you don’t have to give up tight breasts if that’s your thing). The truth is that taking care of your overall health may be your best bet to increase your testosterone levels.
Proven strategies to increase testosterone and increase sperm production include:
- Managing chronic disease through diet, exercise, and other lifestyle changes.
- Human chorionic gonadotropin (HCG) injections – a hormone therapy that can help your testicles increase testosterone levels within the testicles and improve sperm production.
- I don’t smoke.
- Not using illegal drugs.
- Limiting the use of alcohol.
When to see a fertility specialist
If you know you have low testosterone, or if you and your partner have been trying to conceive for six months to a year without success, a visit to a fertility specialist should be your next step, says Dr. Pants.
A fertility specialist can test you and your partner for any fertility problems and recommend options to increase your chances of conceiving or growing a family. They can also discuss with you options such as intrauterine insemination (IUI) and in vitro fertilization (IVF). Dr. Pantalone says it’s extremely important that you and your partner are evaluated when undergoing an investigation into the causes of infertility.
Living with reduced fertility can be emotionally painful and isolating. People living with fertility problems often report feeling depressed, sad, or inadequate. The support of your partner, talking to a licensed mental health professional, and finding community with others who share your experience can help. Ask your health care provider about mental health support, such as therapy and support groups, for people experiencing infertility—you’re not alone, and there is hope.